Healthcare Provider Details

I. General information

NPI: 1922099183
Provider Name (Legal Business Name): PEDRO DELOSTRINOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3240 W FRANKLIN BLVD
CHICAGO IL
60624-1511
US

IV. Provider business mailing address

3760 W GRANVILLE AVE
CHICAGO IL
60659-3126
US

V. Phone/Fax

Practice location:
  • Phone: 773-722-3230
  • Fax:
Mailing address:
  • Phone: 773-588-3819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036058123
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: